Illuminated surgical retractor

ABSTRACT

A illuminated surgical retractor for illuminating a subcutaneous surgical field in the space between a vessel, such as the saphenous vein, and the subcutaneous tissue when the illuminated retractor is used to retract the subcutaneous tissue away from the superior surface of the vessel, the illuminated surgical retractor having a handle connected at an acute angle to a distal end of a first blade section, a second blade section that is connected, and substantially co-planer, to the first blade section, a distal end of the second blade section defining an illumination input end, a connector coupled to the illumination input end so that a source of illumination can be optically coupled, via the connector, to the illumination input end so that the second blade section is substantially illuminated, and, alternatively, a bent tip extending from the proximal end of the first blade section to aid in the required dissection of the intervening tissue.

This application is a continuation of U.S. Ser. No. 09/071,786 filed onMay 1, 1998, Now U.S. Pat. No. 6,228,025.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates, in general, to vessel harvesting and, inparticular, to a new and useful illuminated retractor for creating aworking space for dissecting instruments in support of a surgicalprocedure such as a coronary bypass procedure or other type of vesselharvest procedures.

2. Background Art

In certain surgical procedures, it is necessary to remove a section of ablood vessel from a patient for use in another part of the patient'sbody or for transplanting into a second patient's body. For example, asection of the saphenous vein may be removed for use in coronary bypasssurgery to replace coronary arteries which supply blood to the heart. Asa result of aging and disease, coronary arteries may become blocked byplaque deposits, stenosis, or cholesterol. In some instances, theseblockages can be treated with angioplasty, atherectomy or stentplacement, and coronary bypass surgery is not required. Coronary bypasssurgery is required when these other methods of treatment cannot be usedor have failed to clear the blocked artery.

In the coronary bypass surgery, a vein is harvested from elsewhere inthe body and grafted into place between the aorta and the coronaryartery beyond the point of blockage. It is preferred to use a vein takenfrom the patient undergoing the bypass surgery since the patient is aready source of suitable veins that will not be rejected by the bodyafter transplantation. The saphenous vein in the leg is typically thebest substitute for small arteries such as the coronary arteries becausethe saphenous vein is typically 3 to 5 mm in diameter (about the samesize as the coronary arteries) and it is thus the preferred vein for usein coronary bypass surgery. Also, the venous system of the legs issufficiently redundant so that after removal of the saphenous vein,other veins that remain in the leg are adequate to provide adequatereturn blood flow. The cephalic vein in the arm is an alternative thatis sometimes used.

The conventional, non-endoscopic, surgical procedure for the removal ofthe long saphenous vein as a graft in coronary and vascular surgery mayrequire the surgeon to make one long incision from the groin to the kneeor the ankle of the patient's leg to allow access to the saphenous vein.Alternatively, if the surgeon uses several long incisions, one or moresmall skin bridges are left along the line of the incisions. Whilehandling of the vein should be kept to a minimum, the vein must beseparated from the connective tissue, and that requires the applicationof some force. After exposing the vein, the surgeon grasps it with hisfingers while stripping off the surrounding tissues with dissectingscissors or other scraping instruments. The surgeon uses his fingersand/or blunt dissection tools to separate the vein from the surroundingtissue. To reach under the small skin bridges, the surgeon lifts theskin with retractors and dissects the vein free. When the vein has beencompletely separated from the surrounding tissue and the tributary veinsthat feed into the saphenous vein, the surgeon cuts the proximal anddistal ends of the vein and removes the vein from the leg. Afterremoval, the vein is prepared for implantation into the graft site andthe long incisions made in the leg are closed, for example by suturingor staples.

As can be seen from the description of the conventional, non-endoscopic,vessel harvesting operation, the vessel harvesting operation is verytraumatic in its own right. In the case of coronary artery bypass, thisoperation is carried out immediately before the open chest operationrequired to graft the harvested vein into the coronary arteries.Unfortunately, the vein harvesting operation is often the mosttroublesome part of the operation for the patent The long incision, orincisions, involves the risk of injury to the medial lymph bundle andthe risk of infection of the extensive operation site itself The leg maythus, in addition to being very painful, be slow to heal, or may notheal properly, especially with those patients who have poor circulationin their extremities, and can consequently hinder the patient's recoverfrom the operation. It is therefore desirable to perform the vesselharvesting procedure in as minimally invasive a manner as feasible.

One alternative for minimally invasive vessel harvesting uses anendoscopically controlled vessel removal. In contrast to the open longincision method, the surgeon can limit himself to 2-3 small incisions onthe proximal thigh, at the level of the knee joint and perhaps the innermalleolus. Such minimally invasive or endoscopic vessel harvesting isknown in the surgical field. Viewing the tools through an endoscope orlaparoscope, or a video display from the endoscope, the surgeontypically grasps and holds the saphenous vein with a grasper which isintroduced through the lumen of an endoscope. After connective tissue isdissected from around the vein, the vein is ligated and transected andremoved via the lumen of the endoscope. Alternatively, as the vein iswithdrawn into the lumen of the endoscope, the endoscope may bemaneuvered along the length of the vein while side branches of the veinare ligated and transected whenever encountered. The endoscopic removalmethods leave tissues intact and the vein is prepared and removed undervisual conditions. With the same operating time relative to the veinharvesting, postoperative complaints and the risk of wound infection areconsiderably less than with the conventional, non-endoscopic, procedure.

There are several drawbacks to the endoscopic vessel harvesting methoddescribed above. First, the endoscopic or laproscopic methods requirethe surgeon to view the tools and the operating field through thedistorted visual perspective provided by the endoscope, laparoscope, orthe video display from the endoscope, which is a poor substitute for theactually visualization of the surgical field by the surgeon's naked eye.Second, compounding the first drawback, in practicing this method thereis limited visibility of the saphenous vein and its side branchesbecause viewing is limited to the immediate area directly in front ofthe endoscope. Third, the illumination within the subcutaneous spacecreated by this type of endoscope is also limited to the light emitteddirectly at the distal portion of the endoscope. Another drawback tothis type of procedure is that the side branches of the saphenous veinlimit the maneuverability of the endoscope since the outer edge of theendoscope body is prevented from advancing along the trunk of thesaphenous vein until the encountered side branches are ligated andtransected thereby. Once freed, the endoscope is then maneuvered untilthe next side branch is encountered. Moreover, it has been found thatmethods that utilize this type of endoscope, i.e. an endoscope having alumen, provide a working space that is very restricted because the sidewalls of the scope body constrain the working instrumentation to alimited area. It would be desirable to use a procedure that overcomesthe drawbacks inherent to the endoscopic vessel harvesting method.

In an alternative minimally invasive technique for harvesting a bloodvessel that overcomes the drawbacks of the endoscopic method, thesurgeon utilizes 2-3 small incisions on the proximal thigh, at the levelof the knee joint and perhaps the inner malleolus, which results inseveral long skin bridges between the incisions. To reach under the skinbridges, the surgeon lifts the skin with retractors and exposes thevein. After exposing the vein, the surgeon uses his fingers and/or bluntdissection tools to separate the vein from the surrounding tissues. Itis desirable for the retractor to have some means of aiding thedissection of the surrounding tissues so that the trauma and timerequired for the procedure is limited. When the vein has been completelyseparated from the surrounding tissue and the tributary veins that feedinto the saphenous vein, the surgeon cuts the proximal and distal endsof the vein and removes the vein from the leg. After removal, the veinis prepared for implantation into the graft site, and the 2-3 smallincisions made in the leg are sutured or stapled closed. Because thedissection of the vein is accomplished by the surgeon's fingers and/orby blunt dissection, this technique may be accomplished by the surgeonin a more timely manner than the endoscopic method. This alternativetechnique is a minimally invasive technique that, just like theendoscopic method described above, consequently minimizes the risks andcomplications of the surgery.

This technique overcomes the endoscopic method drawbacks of limitedmovement and limited workspace of the procedure enabling instrumentationand the limited and distorted visual perspective provided by theendoscope, laparoscope, or the video display from the endoscope.However, one drawback remains. Using prior art retractors, theillumination of the surgical field is poor. By necessity of theminimally invasive nature of the procedure, the vessel harvestingprocedure is primarily conducted under the long skin bridges leftbetween the small incisions. Because the skin bridges are so long, it isdifficult to sufficiently illuminate the subcutaneous space between thevessel and the subcutaneous tissue when retractors known in the art areused to retract the tissue away from the superior surface of the vessel.With insufficient illumination of the surgical field, the advantages ofthe surgeon being able to maneuver freely and to optically visualize thesurgical field using the benefit of his own binocular vision during thecourse of the minimally invasive procedure are eroded. It is thereforedesirable to provide a means of providing illumination to thesubcutaneous space formed by the retractor so that the surgeon canefficiently view and operate in the entire surgical field exposed by theretractor.

SUMMARY OF THE INVENTION

The present invention overcomes the disadvantages of the prior art.Specifically, as best shown in FIGS. 1 and 2A, the present inventionprovides for an illuminated retractor for illuminating the subcutaneousspace between a vessel, such as the saphenous vein which is located in apatient's leg, and the subcutaneous tissue when the illuminatedretractor is used to retract the tissue away from the superior surfaceof the vessel.

In the contemplated minimally invasive operation for harvesting a bloodvessel, the surgeon utilizes 2-3 small incisions on the proximal thigh,at the level of the knee joint and perhaps the inner malleolus whichresults in several long skin bridges between the incisions. To exposethe length of the vein remaining under the long skin bridges, thesurgeon lifts the skin and the subcutaneous tissue with the illuminatedretractor. The illuminated retractor provides a large, well illuminatedsurgical field, extending the substantial length of the retractor withinthe subcutaneous space created by the retractor. With the vein thusexposed, the surgeon uses his fingers and/or blunt dissection tools toseparate the vein from the surrounding tissues. When the vein has beencompletely separated from the surrounding tissue and the tributary veinsthat feed into the saphenous vein, the surgeon cuts the proximal anddistal ends of the vein and removes the vein from the leg. After removalthe 2-3 small incisions made in the leg are sutured or stapled closedand the vein harvesting procedure is completed.

The illuminated surgical retractor has a handle, a first blade section,a second blade section, and a connector. The handle, which is preferablycontoured to be gripped by the operating surgeon, is connected to thefirst blade section at the distal end of the first blade section, thuspermitting one-handed use by the surgeon. The handle permits theretractor to be lifted at any angle with respect to the axis of the veinand, when a pulling force is applied to the handle, a correspondingpulling or retractive force is applied to the subcutaneous tissue viathe first blade section, which creates the subcutaneous space beneaththe subcutaneous tissue when the subcutaneous tissue is drawn away. Thehandle may also have an elongated rod extending from the opposite end ofthe handle that allows the retractor to be maneuvered into the desiredposition by the surgeon and then fixed in the desired relative positionby clamping or grasping the retractor with the available operating tablemechanisms.

The first blade section has a first blade proximal end, a first bladedistal end, a first blade outer surface, and a first blade innersurface. Similarly, the second blade section, which is preferablysubstantially transparent, has a second blade proximal end, a secondblade distal end, a second blade outer surface and a second blade innersurface. The second blade outer surface of the second blade section isconnected to the first blade section inner surface of the first bladesection such that the first and second blade sections are substantiallyparallel.

The first blade proximal end has a rounded shape or a smoothly radiusedpointed shape that allows the retractor to be pushed into the smallincision made by the surgeon and thrust forward and maneuvered throughthe connective tissue between the subcutaneous tissue and the vessel tobe harvested. Similarly, the proximal end of the second blade sectionhas a rounded shape or, alternatively, a smoothly radiused pointedshape. The shape of the second blade section proximal end is preferablycomplementary to the shape of the first blade section proximal end sothat the proximal end of the retractor, when the first and second bladesections are connected, can readily penetrate the connective tissueunder the subcutaneous tissue as the retractor is inserted into thesmall incision and maneuvered into position.

The illuminated surgical retractor may also have a bent dissecting tipwhich extends from the first blade section at the proximal end of thefirst blade section. This bent dissecting tip allows the surgeon to usethe bent tip as a dissecting device as the retractor is inserted andmaneuvered around and/or through the connective tissue surrounding thevessel to be harvested.

In order to enhance the reflective qualities of the illuminateretractor, the first blade inner surface of the first blade sectionpreferably has a mirrored surface. Also, the second blade inner surfaceof the second blade section preferably has a graded dot screen surface.The mirrored surface of the first blade inner surface and the graded dotscreen surface of the second blade inner surface act to minimize thelight intensity loss of the light energy that is provided to thesurgical field by the illuminated retractor.

The connector of the retractor is coupled to the illumination input endthat is defined by the distal end of the second blade section. Theconnector is adapted to receive and releasably retain a distal connectorof a light cable that is connected to a source of illumination so thatthe illumination input end is optically coupled to the source ofillumination, thereby allowing light energy to enter the second bladesection via the illumination input end. The light energy fills thesecond blade section and turns the second blade section into a “lightpipe.” The light energy is, in turn, radiated from the second bladesection into the subcutaneous space between the vessel and thesubcutaneous tissue exposed by the retractor. In this manner, light canbe provided from the light source via the cable to the illuminationinput end of the second blade section so that the second blade sectionis illuminated, which results in an illuminated surgical field.

BRIEF DESCRIPTION OF THE FIGURES OF THE DRAWINGS

Embodiments of the invention are described by way of example withreference to the accompanying drawings, in which:

FIG. 1 is a perspective view of the manipulation of an illuminatedretractor according to the present invention;

FIG. 2A is an exploded perspective view of the illuminated retractoraccording to the present invention;

FIG. 2B is a cross-sectional view of the first and second blade sectionsof the illuminated retractor shown in FIG. 1;

FIG. 3 is an exploded perspective view of a second embodiment of anilluminated retractor according to the present invention;

FIG. 4 is a perspective view of the manipulation of a third embodimentof an illuminated retractor according to the present invention;

FIG. 4A is an exploded perspective view of a third embodiment of theilluminated retractor according to the present invention;

FIG. 4B is a cross-sectional view of the first and second blade sectionsof the illuminated retractor shown in FIG. 4;

FIG. 5A is a perspective view of a first bayonet member and a secondbayonet showing the capture of the distal end of the second bladesection;

FIG. 5B is a fragmentary cross-sectional view of a bayonet fastener withthe distal end of the second blade section secured;

FIG. 6A is an exploded perspective view of a fourth embodiment of anilluminated retractor according to the present invention;

FIG. 6B is an exploded cross-sectional view of the illuminated retractorshown in FIG. 6A;

FIG. 7 is an exploded perspective view of a fifth embodiment of theilluminated retractor of the present invention showing the bentdissecting tip of the retractor;

FIG. 8 is a fragmentary top-view of the bent tip outer surface showingthe dissecting serrations of the illuminated retractor shown in FIG. 7;

FIG. 9 is a fragmentary cross-sectional view of the first blade sectiontaken through line 9—9 of the illuminated retractor shown in FIG. 7showing the profile of the dissecting serrations in the bent tip of theretractor and the obtuse angle formed between the bent tip and theextended longitudinal axis of the first blade section.

DETAILED DESCRIPTION OF THE INVENTION

The present invention is more particularly described in the followingexamples that are intended as illustrative only since numerousmodifications and variations therein will be apparent to those skilledin the art. As used in the specification and in the claims, “a” can meanone or more, depending on the context in which it is used.

The present invention provides for an illuminated retractor forilluminating the subcutaneous space between a vessel, such as thesaphenous vein which is located in a patient's leg, and the subcutaneoustissue when the illuminated retractor is used to retract the tissue awayfrom the superior surface of the vessel.

Referring first to FIGS. 1 and 2A, there is shown a first embodiment ofthe present invention encompassing an illuminated surgical retractor 10having a handle 20, a first blade section 30, a second blade section 40,and a connector 50.

The handle 20 has a first handle end 22 and a second handle end 24. Thesecond handle end 24 of the handle 20 is connected to the first bladesection 30 at the distal end 32 of the first blade section 30 forpermitting one-handed use by the surgeon. The angle α formed by thehandle 20 and the first blade section 30 is acute and is preferablybetween 30° and 65°. The best combination of retractor mobility andapplication of retractive pulling force occurs when the acute angle αbetween the handle 20 and the first blade section 30 is approximately45°. The handle 20 permits the retractor 10 to be lifted at any anglewith respect to the axis of the vein and, when a pulling force isapplied to the handle 20, a retractive force is applied to thesubcutaneous tissue via the first blade section 30 which createssubcutaneous space beneath the subcutaneous tissue when the subcutaneoustissue is drawn away. The handle 20 of the retractor 10 is alsopreferably contoured to be gripped by the hand of a surgeon thusproviding more tactile feel and feedback as well as increasing thesurgeon's comfort in using and maneuvering the retractor.

The handle 20 may also have an elongated rod 26 extending from the firsthandle end 22. The elongated rod 26 allows the retractor 10 to be fixedor grasped by operating table mechanisms known in the art so that theretractor 10 may be fixed in position. The elongated rod 26 allows theretractor 10 to be maneuvered into the desired position by the surgeonand then fixed in the desired relative position thus freeing both of thesurgeon's hands for the dissection of the exposed vessel.

The first blade section 30 has a first blade proximal end 34, a firstblade distal end 32, a first blade outer surface 36, and a first bladeinner surface 38. As shown in FIG. 2A, the first blade outer surface 36and the first blade inner surface 38 extend from the proximal end 34 ofthe first blade section 30 to near the distal end 32 of the first bladesection 30. More specifically, as the first blade section 30 nears thefirst blade distal end 32, the first blade section 30 tapers into ashaft shape 31 which then bends to form the preferred acute angle α withthe handle 20. The first blade outer surface 36 and the first bladeinner surface 38 correspondingly are eliminated as the first bladesection 30 tapers into the shaft shape 31. As previously noted, thefirst blade distal end 32 is connected to the second handle end 24 ofthe handle 20. The first blade proximal end 34 has a rounded shape or asmoothly radiused pointed shape that allows the retractor 10 to bepushed into the small incision made by the surgeon and thrust forwardand maneuvered through the connective tissue between the subcutaneoustissue and the vessel to be harvested.

The second blade section 40 has a second blade proximal end 44, a secondblade distal end 42, a second blade outer surface 46 and a second bladeinner surface 48. As shown in FIG. 2A, the second blade outer surface 46and the second blade inner surface 48 extend from the proximal end 44 ofthe second blade section 40 to near the distal end 42 of the secondblade section 40. More specifically, as the second blade section 40nears the second blade distal end 42, the second blade section 40 tapersinto a shaft shape 41 which then bends. This bend in the second bladesection 40 allows the distal end 42 of the second blade section 40 toremain substantially relatively parallel to the first blade section 30as the first blade section 30 bends. The second blade outer surface 46and the second blade inner surface 48 correspondingly are eliminated asthe second blade section 40 tapers into the shaft shape 41.

The second blade section 40 is preferably substantially transparent andis preferably made of a transparent plastic, such as a transparent acrylresin, which has the benefit of being highly resistant to breakage whileretaining the ability to flex or deform under pressure and then returnundamaged to the original, unstressed configuration However, the secondblade section 40 can also be made of glass or other types of knownsubstantially transparent material.

The second blade outer surface 46 of the second blade section 40 isconnected to the first blade inner surface 38 of the first blade section30 such that the first and second blade sections 30, 40 aresubstantially parallel along the substantial length of the first andsecond blade sections 30,40. The second blade section 40 may beconnected to the first blade section 30 in any manner known in the artthat is within the level of ordinary skill of one in the surgical field.

As shown in FIG. 2A, the second blade outer surface 46 may be chemicallybonded to the first blade inner surface 38 through the use of anadhesive or by other chemical bonding means known to one skilled in theart. This chemical bonding may permanently affix the first and secondblade sections 30, 40 or may preferably allow the first and second bladesections 30, 40 to be releasably connected for ease of sterilization ofthe respective blade sections 30, 40. Alternatively, the second bladesection 40 may be mechanically fixed to the first blade section 30, bymeans apparent to one skilled in the art, such that the first and secondblade sections 30, 40 may be releasably connected to each other.

The second blade proximal end 44 of the second blade section 40 has arounded shape or, alternatively, a smoothly radiused pointed shape. Theshape of the second blade proximal end 44 is preferably complementary tothe shape of the first blade proximal end 34 so that the proximal end 11of the retractor 10, when the first and second blade sections 30, 40 areconnected, can readily penetrate the connective tissue under thesubcutaneous tissue as the retractor is inserted into the small incisionand maneuvered into position.

As illustrated in FIG. 2B, the first blade section 30 preferably has acurved cross-sectional shape. The curved cross-section of the firstblade section 30 causes the first blade outer surface 36 to be convex.The convex cross-sectional shape of the first blade outer surface 36 ofthe first blade section 30 aids in the prevention of unnecessary traumato the retracted tissue, as the first blade outer surface 36, which isin contact with the subcutaneous tissue when the pulling force isapplied to the retractor 10, presents no sharp edges that could causetearing of the tissue. Rather, the shape aids in distributing the forceapplied to the retracted tissue by the first blade section 30.

Still referring to FIG. 2B, the first blade inner surface 38 of thefirst blade section 30 is preferably concave in cross-section. The outersurface 46 of the second blade section 40 may define a convex curve incross-section that is complementary to the preferred concavecross-sectional shape of the inner surface 38 of the first blade section30. As will be obvious to one skilled in the art, if a complementary fitof the outer surface 46 of the second blade section 40 and the inner.surface 38 of the first blade section 30 is desired, the outer surface46 of the second blade section 40 may have any geometric cross-sectionthat allows the second blade outer surface 46 to complementarily fitagainst the inner surface 38 of the first blade section 30, as there isno requirement that the first blade inner surface 38 be concave incross-section.

There is no constraint requiring that the outer surface 46 of the secondblade section 40 be complementarily shaped to the inner surface 38 ofthe first blade section 30 The only constraint on the shape of thegeometric cross-section of the second blade section 40 is that thechosen geometric cross-section should allow the second blade section 40to be connected, by means know in the art, to the first blade section 30such that the first and second blade sections 30, 40 are connected andsubstantially parallel.

The inner surface 48 of the second blade section 40 may be concave incrosssection. Alternatively, the inner surface 48 of the second bladesection 40 could be substantially flat or convex in cross-section.

In order to enhance the reflective qualities of the illuminate retractor10, the first blade inner surface 38 of the first blade section 30preferably has a mirrored surface 39. Also, the second blade innersurface 48 of the second blade section 40 preferably has a graded dotscreen surface 49. The mirrored surface 39 of the first blade innersurface 38 and the graded dot screen surface 49 of the second bladeinner surface 48 act to minimize the light intensity loss of the lightthat is provided to the surgical field by the illuminated retractor 10.

The illumination input end 43 at the second blade distal end 42 of thesecond blade section 40 allows light energy to enter the second bladesection 40. The light energy fills the second blade section 40, turningthe second blade section 40 into a “light pipe.” The light energy is, inturn, radiated from the second blade section 40, and particularly fromthe inner surface 48 of the second blade section 40, into thesubcutaneous space between the vessel and the subcutaneous tissueexposed by the retractor 10. Since substantially the entire length ofthe second blade section 40 is illuminated, a large, well illuminatedsurgical field, extending the substantial length of the second bladesection 40 of the retractor 10, is provided for the surgeon to operate.This allows the surgeon to dissect the vein in an minimally invasivemanner without the need for viewing the surgical field throughendoscopic visual devices.

The connector 50 is coupled to the illumination input end 43 which isdefined by the distal end 42 of the second blade section 40 of theretractor 10. The connector 50 is adapted to receive and releasablyretain a distal connector [not shown] of a light cable [not shown] thatis connected to a source of illumination [not shown] so that theillumination input end 43 is optically coupled to the source ofillumination. In this manner, light can be provided from the lightsource via the cable to the illumination input end 43 of the secondblade section 40 so that the second blade section 40 is illuminated.

FIG. 3 shows a second embodiment of a illuminated retractor 12 of thepresent invention. The construction of the second embodiment is similarto the first embodiment and, accordingly, uses the same referencenumbers for similar components. The components in FIG. 3 that use thesame reference numerals as in FIGS. 1-2B are substantially equivalentand, therefore, the description thereof is omitted for the secondembodiment. The second embodiment of the present invention encompassesan illuminated surgical retractor 12 having a handle 20, a first bladesection 30, a second blade section 40, a means for connecting the firstand second blade sections, and a connector 50.

Still referring to FIG. 3, the means for connecting the first bladesection 30 to the second blade section 40 preferably comprises aplurality of screws 60, or, alternatively, bolts, releasably connectingthe outer surface 46 of the second blade section 40 to the inner surface38 of the first blade section 30. It is preferable to locate the screws60 along the periphery of the second blade section 40 to minimize theshadows caused by the screws 60, which could degrade the lightillumination of the retractor 12.

FIGS. 4-4B show a third embodiment of an illuminated retractor 13 of thepresent invention. The construction of the third embodiment is similarto the first embodiment and, accordingly, the figures use the samereference numbers for similar components. The components in FIGS. 4-4Bthat use the same reference numerals as in FIGS. 1-2B are substantiallyequivalent and, therefore, the description thereof is omitted for thethird embodiment. The third embodiment of the present inventionencompasses an illuminated surgical retractor 13 having a handle 20, afirst blade section 30, a second blade section 40, a means forconnecting the first and second blade sections, and a connector 50.

Referring to FIG. 4A, the means for connecting the first blade section30 to the second blade section 40 comprises a socket means 70 and apinning means 80. The socket means 70 releasably receives the distal end42 of the second blade section 40 while the pinning means 80 releasablyreceives the proximal end 44 of the second blade section 40 so that thesecond blade section 40 may be releasably connected to the first bladesection 30. Referring to FIGS. 4A-4B and 5A-5B, the socket means 70 ispreferably a bayonet fastener 71 having a first bayonet member 72 thatis connected to the first blade section 30 near the distal end 32 of thefirst blade section 30 and a second bayonet member 76 that is connectedto the second blade section 40 near the distal end 42 of the secondblade section 40. The first bayonet member 72 and the second bayonetmember 76 are complementarily sized and shaped so that the first bayonetmember 72 and the second bayonet member 76 may be complementarilyreleasably engaged. Preferably, the first bayonet member 72 has anexterior first bayonet surface having a threaded surface 90 and thesecond bayonet member 76 has a complementary threaded interior secondbayonet surface 92.

Preferably, the first bayonet member 72 has a first top surface 73 and afirst bottom surface 74. A first bore 75 extends through the firstbayonet member 72 from the first top surface 73 to the first bottomsurface 74. Similarly, the second bayonet member 76 has a second topsurface 77 and a second bottom surface 78 having a second bore 79extending therethrough from the first top surface 73 to the first bottomsurface 74. The second top surface 77 of the cap member defines aindented cap shape 91 having the threaded interior second bayonetsurface 92 and a shoulder surface 94. The shoulder surface 94 surroundsthe second bore 79 of the second bayonet member 76. Preferably, thesecond bore 79 is a keyway 96. The first bore 75 of the first bayonetmember 72 and the second bore 79, ie., the keyway 96, of the secondbayonet member 76 are substantially co-axially aligned when the firstbayonet member 72 and the second bayonet member 76 are engaged.

The distal end 42 of the second blade section 40, which preferably has ashaped lip 45 around the distal end 42 of the second blade section 40that matches the defined shape of the keyway 96 of the second bayonetmember 76, can thereby extend into and through the keyway 96 of thesecond bayonet member 76. The distal end 42 of the second blade section40 is then secured relative to the first blade section 30 upon therotation of the second bayonet member 76 relative to the fixed firstbayonet member 72. This rotation causes the keyway 96 of the secondbayonet member 76 to correspondingly rotate, thus securing the shapedlip 45 of the distal end 42 of the second blade section 40 andpreventing the detachment of the distal end 42 of the second bladesection 40.

When secured, the distal end 42 of the second blade section 40 projectsabove the shoulder surface 94 of the second bayonet member 76. Thisallows the illumination input end 43, located at the distal end 42 ofthe second blade section 40, to be disposed near the first bore 75 ofthe first bayonet member 72 when the first and second bayonet members72, 76 are engaged. The first top surface 73 of the first bayonet member72 is shaped and adapted to act as the connector 50 for the retractor13, thereby allowing the connector 50 at the first top surface 73 of thefirst bayonet member 72 to receive and releasably retain a distalconnector of a light cable that is connected to a source ofillumination, so that the illumination input end 43 of the second bladesection 40 is optically coupled to the source of illumination. In thismanner, light can be provided from the light source via the cable to theillumination input end 43 of the second blade section 40, so that thesecond blade section 40 is illuminated.

Referring to FIG. 4A, the pinning means 80 is preferably a plurality ofangled pins 82 extending from the inner surface 38 of the first bladesection 30 near the proximal end 34 of the first blade section 30. Thepins are sized so that the first and second blade sections 30, 40 aremated to each other, forcing the second blade section 40 into closecooperation with the first blade section 30, when the proximal end 44 ofthe second blade section 40 is inserted underneath the pins 82. The pins82 grasp and secure the abutting portions of the second blade section 40near the proximal end 44 of the second blade section 40 when the firstand second bayonet members 72, 76 are complementarily engaged.

When the first blade section 30 and the second blade section 40 areconnected by the bayonet fastener 71 and the plurality of pins 82 in thefashion described above, the cross-sectional shape of the outer surface46 of the second blade section 40 may be, but is not required to be,complementarily shaped to the cross-sectional shape of the inner surface38 of the first blade section 30.

FIGS. 6A-6B show a fourth embodiment of a illuminated retractor 14 ofthe present invention. This embodiment is a variation of the thirdembodiment. Specifically, the pinning means 80 is varied. Theconstruction of the fourth embodiment is similar to the first and thirdembodiments and, accordingly, the figures use the same reference numbersfor similar components. The components in FIGS. 6A-6B that use the samereference numerals as in FIGS. 1-5B are substantially equivalent and,therefore, the description thereof is omitted for the fourth embodiment.

The fourth embodiment of the present invention encompasses anilluminated surgical retractor 14 having a handle 20, a first bladesection 30, a second blade section 40, a means for connecting the firstand second blade sections, and a connector 50. Referring to FIG. 6A, themeans for connecting the first blade section 30 to the second bladesection 40 comprises a socket means 70 and a pinning means 80. Thesocket means 70 releasably receives the distal end 42 of the secondblade section 40 while the pinning means 80 releasably receives theproximal end 44 of the second blade section 40, so that the second bladesection 40 may be releasably connected to the first blade section 30.The socket means 70 used in the fourth embodiment is preferably the sameas described for the third embodiment above. The pinning means 80 usedin the fourth embodiment is preferably a plurality of tabs 84 extendingfrom the inner surface 38 of the first blade section 30 near theproximal end 34 of the first blade section 30. The tabs 84 are sized sothat the second blade section 40 is forced into cooperation with thefirst blade section 30 when the proximal end 44 of the second bladesection 40 is inserted into close cooperation with the tabs 84. Thepreferred shape of the tabs 84 is a dovetail shape, however othergeometric shapes are contemplated.

The tabs 84 grasp and secure the abutting portions of the second bladesection 40 near the proximal end 44 of the second blade section 40 whenthe first and second bayonet members 72, 76 are complementarily engaged.Referring to FIG. 6B, the tabs 84 define a grasping surface 86 betweenthe upper surface 85 of the tabs 84 and the first blade inner surface38. The grasping surface 86 of the tabs 84 preferably forms an acuteangle Δ with the inner surface 38 of the first blade section 30. Thisacute angle Δ of the grasping surface 86 aids in mechanically forcingand retaining the second blade section 40 in cooperation with the firstblade section 30. The tabs 84 have the added advantage of not extendingabove the second blade inner surface 48 of the second blade section 40when the first blade section 30 is connected to the second blade section40, as the upper surface 85 of the tabs 84 is substantially planer tothe outer surface 46 of the second blade section 40, so that theproximal end 11 of the retractor 14 is substantially smooth and presentsno projections that could inflict unnecessary trauma on the patient'stissues or to the operating physician's hands.

The combination of the bayonet fastener 71 and the tabs 84 act to securethe second blade section 40 to the first blade section 30 so that theilluminated retractor 14 can be used in a surgical environment in whichforce is required to be applied to the retractor 14, via the handle 20,in order to expose the necessary subcutaneous space between the vesselto be harvested and the subcutaneous tissue. However, the bayonetfastener 71 and the tabs 84 also allow the second blade section 40 to beseparated from the first blade section 30 by simply rotating the secondbayonet member 76 to align the keyway 96 of the second bayonet member 76with the shaped lip 43 of the distal end 42 of the second blade section40, which has a complementary key shape, withdrawing the distal end 42of the second blade section 40 from the keyway 96 of the second bayonetmember 76, and pulling the second blade section 40 free of the tabs 84extending from the inner surface 38 of the first blade section 30. Thisallows the first and second blade sections 30, 40 to be readilyseparated for ease of sterilization of the retractor 14 components orfor the replacement of the second blade section 40.

When the first blade section 30 and the second blade section 40 areconnected by the bayonet fastener 71 and the plurality of tabs 84 in thefashion described above, the cross-sectional shape of the outer surface46 of the second blade section 40 may be, but is not required to becomplementarily shaped to the cross-sectional shape of the inner surface38 of the first blade section 30.

FIGS. 7-9 show a fifth embodiment of an illuminated retractor 15 of thepresent invention. The construction of the fifth embodiment is similarto the first and fourth embodiments and, accordingly, the figures usethe same reference numbers for similar components. The components inFIGS. 7-9 that use the same reference numerals as in FIGS. 1-6B aresubstantially equivalent and, therefore, the description thereof isomitted for the fifth embodiment.

The fifth embodiment of the present invention encompasses an illuminatedsurgical retractor 15 having a handle 20; a first blade section 30, asecond blade section 40, a bent tip 100, and a connector 50. The firstblade section 30 may be connected to the second blade section 40 in anymanner known in the art that is within the level of ordinary skill ofone in the surgical field. The second blade outer surface 46 of thesecond blade section 40 may be chemically bonded to the first bladeinner surface 38 of the first blade section 30 through the use of anadhesive or by other chemical bonding means known to one skilled in theart. This chemical bonding may permanently affix the first and secondblade sections 30,40 or it may preferably allow the first and secondblade sections 30, 40 to be releasably connected for ease ofsterilization of the respective blade sections 30,40. Alternatively, thesecond blade section 40 may be mechanically fixed to the first bladesection 30, by means apparent to one skilled in the art, such that thefirst and second blade sections 30,40 may be releasably connected toeach other.

Preferably, as shown in FIG. 7, the first blade section 30 is connectedto the second blade section 40 by a socket means 70 and a pinning means80. The socket means 70 releasably receives the distal end 42 of thesecond blade section 40 while the pinning means 80 releasably receivesthe proximal end 44 of the second blade section 40, so that the secondblade section 40 may be releasably connected to the first blade section30. The socket means 70 used in the fifth embodiment is preferably thesame as described for the third embodiment above. The pinning means 80used in the fifth embodiment is preferably the same as described for thefourth embodiment above.

The first blade section 30 has a first blade section proximal end 34, afirst blade section distal end 32, a first blade outer surface 36, and afirst blade inner surface 38. As shown in FIG. 7, the first blade outersurface 36 and the first blade inner surface 38 extend from the proximalend 34 of the first blade section 30 to near the distal end 32 of thefirst blade section 30. More particularly, as the first blade section 30nears the first blade distal end 32, the first blade section 30 tapersinto a shaft shape 31 which then bends to form the preferred acute anglea with the handle 20. In the fifth embodiment, the preferred acute angleα is approximately 60 degrees. The first blade outer and inner surfaces36, 38 correspondingly taper as the first blade section 30 tapers intothe shaft shape 31. As previously noted, the first blade distal end 32is connected to the second handle end 24 of the handle 20.

Still referring to FIG. 7, the second blade section 40 has a secondblade proximal end 44, a second blade distal end 42, a second bladeouter surface 46, and a second blade inner surface 48. The second bladeouter and inner surfaces 46, 48 extend from the proximal end 44 of thesecond blade section 40 to near the distal end 42 of the second bladesection 40. More specifically, as the second blade section 40 nears thesecond blade distal end 42, the second blade section 40 tapers into ashaft shape 41 which then bends. This bend in the second blade section40 allows the distal end 42 of the second blade section 40 to remainsubstantially relatively parallel to the first blade section 30 as thefirst blade section 30 bends.

To aid in the dissection of the connective tissue and to moreefficiently use the force applied to the retractor 15 as the retractor15 is maneuvered through and around the connective tissue, thisembodiment uses a bent tip 100 having a bent tip distal end 101 which isconnected to the proximal end 34 of the first blade section 30.Preferably, the bent tip 100 extends, as a simple extension, from theproximal end 34 of the first blade section 30. As shown in FIG. 9, thebent tip 100, having a bent tip longitudinal axis T, forms an obtuseangle θ relative to a first blade section longitudinal axis L. Thisobtuse angle θ can be between 95°-175° and is preferably approximately160°.

Referring to FIG. 8, the bent tip proximal end 102 has a rounded shapeor a smoothly-radiused pointed shape that allows the retractor 15 to bepushed into the small incision made by the surgeon and maneuveredthrough the connective tissue between the subcutaneous tissue and thevessel to be harvested. The bent tip 100 further has a bent tip outersurface 104 having a plurality of dissecting serrations 106. Each ofthese serrations 106 are preferably at a substantial right angle to thebent tip longitudinal axis T and preferably extend substantially acrossthe width of the bent tip 100. It is contemplated that the serrations106 may be placed at an angle, other than the right angle describedabove, relative to the bent tip longitudinal axis T. It is alsocontemplated that the serrations 106 might be placed at series of anglesto form a graphic series of serrations 106. One example of which wouldbe the use of a plurality of arrow, or v-shaped, serrations 106 with thepoint of the arrow oriented toward the proximal end 102 of the bent tip100.

As shown in FIG. 9, the dissecting serrations 106 preferably have asaw-tooth cross- sectional profile 108. This profile 108 allows theserrations 106 to aid in dissecting intervening connective tissue whenthe retractor 15 is pressed forward into the subcutaneous space andlifted or withdrawn slightly from the subcutaneous space. It iscontemplated that other geometric cross-sectional profiles of theserrations 106, such as a triangle profile, may also be used.

Preferably, as shown in FIGS. 7 and 9, both the first blade outer andinner surfaces 36, 38 preferably have a curved cross-sectional shape.This curved cross-sectional shape causes the first blade outer surface36 to be convex and the first blade inner surface to be concave 38. Theouter surface 46 of the second blade section 40 may have a convexcross-sectional shape that is complementary to the concavecross-sectional shape of the inner surface 38 of the first blade section30. However, there is no requirement or constraint that the second bladeouter surface 46 must have a complementary cross-sectional shape to theinner surface 38 of the first blade section 30.

Still referring to FIGS. 7 and 9, the bent tip 100 preferably has asubstantially planer or flat cross-sectional shape. Alternatively, thebent tip 100 could have a curved cross-sectional shape which iscomplementary to the curved cross sectional shape of the first bladeouter surface 36.

The purpose of the bent tip 100 of the retractor 15 of this embodimentis to help the surgeon translate some of the applied force to theretractor 15 into a dissecting force by letting the bent tip 100, withthe dissecting serrations 106, perform some of the required dissectingwork. By having the retractor 15 accomplish some of the dissectingrequired by the vessel harvesting procedure, the surgeon can, whilestill performing in a minimally invasive manner, more rapidly completethe surgical procedure, which results in reduced surgical time andpossibility of trauma to the patient from the surgery.

The present invention has been described in reference to use inharvesting blood vessels. It would be obvious to one skilled in the artthat the present invention could also be used in other minimallyinvasive surgical procedures in which the illumination of the minimallyinvasive surgical field is desired.

Although only four types of connecting means are shown in FIGS. 2A-6Bfor detachably connecting the second blade section 40 to the first bladesection 30 of the retractor, any type of connecting means can beutilized. Thus, the detachable connection feature of the second bladesection 40 of the present invention is not limited to the connectingmeans described above, but, rather, can be connected in a manner wellwithin the level of ordinary skill of one in the surgical field.Furthermore, although the present invention has been described withreference to specific details of certain embodiments thereof, it is notintended that such detail should be regarded as limitations upon thescope of the invention except as and to the extent that they areincluded in the accompanying claims.

What is claimed is:
 1. An illuminated surgical retractor comprising: ahandle having a first handle end portion and a second handle endportion; a first blade section having a first blade proximal end portionand a first blade distal end portion with a first blade inner surfaceextending between the first blade proximal end portion and the firstblade distal end portion and said second handle end portion of saidhandle connected to said first blade distal end portion of said firstblade section and wherein said first blade section is sized to bereceived in a subcutaneous space of a patient between a vessel andsubcutaneous tissue such that said handle forms an acute angle with saidfirst blade section; second blade section having a second blade proximalend portion and a second blade distal end portion with a second bladeouter surface extending between the second blade proximal end portionand the second blade distal end portion, a second blade inner surfaceextending between the second blade proximal end portion and the secondblade distal end portion, the second blade distal end portion of saidsecond blade section defining an illumination input end portion; aconnecting member to connect said second blade section to said firstblade section such that said first and second blade sections aresubstantially parallel; and a connector coupled to the illuminationinput end portion, said connector sized to optically couple theillumination input end portion to a source of illumination so that saidsecond blade is substantially illuminated.
 2. The illuminated surgicalretractor of claim 1, wherein said second blade section is substantiallytransparent.
 3. The illuminated surgical retractor of claim 1, whereinsaid first blade section is sized to be received in a subcutaneous spaceof a patient between a vessel and subcutaneous tissue and said handle isoriented with respect to said first blade section to enable the user toretract tissue away from the vessel and said handle is oriented at anacute angle of less than 65 degrees with respect to said first bladesection.
 4. An illuminated surgical retractor comprising: a handlehaving a first handle end portion and a second handle end portion; afirst blade section having a first blade proximal end portion, a firstblade distal end portion, and a first blade inner surface, extendingfrom the first blade proximal end portion to near the first blade distalend portion, the second handle end portion of said handle connected tothe first blade distal end portion of said first blade section such thatsaid handle forms an acute angle with said first blade section; a secondblade section having a second blade proximal end portion, a second bladedistal end portion, a second blade outer surface, extending between thesecond blade proximal end portion and the second blade distal endportion, and a second blade inner surface extending between the secondblade proximal end and the second blade distal end portion, said secondblade section connected to said first blade section such that said firstand second blade sections are substantially parallel and the secondblade distal end portion of said second blade section defining anillumination input end portion; and a connector coupled to theillumination input end portion, said connector sized to optically couplethe illumination input end portion to a source of illumination so thatsaid second blade section is substantially illuminated.
 5. Theilluminated surgical retractor of claim 4, wherein said first bladesection has a first blade outer surface that defines a convex curve incross-section, and wherein the first blade inner surface of said firstblade section defines a concave curve in cross-section.
 6. Theilluminated surgical retractor of claim 5, wherein the second bladeouter surface of said second blade section defines a convex curve incross-section complementary to the second blade inner surface andwherein the second blade inner surface of said second blade sectiondefines a concave curve in cross-section.
 7. The illuminated surgicalretractor of claim 4, wherein second blade section is substantiallytransparent.
 8. The illuminated surgical retractor of claim 7, whereinthe acute angle formed between said handle and said first blade sectionis between about 30° to 65°.
 9. The illuminated surgical retractor ofclaim 4, wherein said first blade section includes a bent tip thereon.10. The illuminated surgical retractor of claim 9 wherein said bent tipincludes a bent tip proximal end portion and a bent tip distal endportion, the bent tip distal end portion of said bent tip is connectedto the first blade proximal end portion of said first blade section suchthat said bent tip forms an obtuse angle with said first blade section.11. The illuminated surgical retractor of claim 10, wherein the bent tipproximal end of said bent tip has a round shape.
 12. The illuminatedsurgical retractor of claim 10, wherein the bent tip proximal endportion of said bent tip has a smoothly-radiused pointed shape.
 13. Theilluminated surgical retractor of claim 10, wherein said bent tip has asubstantially flat cross-sectional shape.
 14. The illuminated surgicalretractor of claim 9, wherein said bent tip has a tip longitudinal axisand a bent tip outer surface, the bent tip outer surface having aplurality of dissecting serrations oriented at substantially rightangles to the longitudinal axis of the bent tip and extendingsubstantially across the width of the bent tip.
 15. The illuminatedsurgical retractor of claim 14, wherein said dissecting serrations havea saw-tooth-sectional profile.
 16. An illuminated surgical retractor foruse in dissecting tissue in a subcutaneous space, said retractorcomprising: a handle having a first handle end portion and a secondhandle end portion; a first blade section having a first blade proximalend portion with a first blade distal end portion, and a first bladeinner surface, extending from the first blade proximal end portion tonear the first blade distal end portion, the second handle end portionof said handle connected to the first blade distal end portion of saidfirst blade section and wherein said first blade section is sized to bereceived in a subcutaneous space of a patient between a vessel andsubcutaneous tissue and said handle is oriented with respect to saidfirst blade section to enable the user to retract tissue away from thevessel; a second blade section having a second blade proximal endportion with a second blade distal end portion and a second blade outersurface, extending between the second blade proximal end portion and thesecond blade distal end portion, and a second blade inner surfaceextending between the second blade proximal end portion and the secondblade distal end portion, said second blade section is connected to saidfirst blade section such that said first and second blade sections aresubstantially parallel, the second blade distal end portion of saidsecond blade section defining an illumination input end portion; aconnector coupled to the illumination input end portion wherein saidconnector is sized to optically couple the illumination input endportion to a source of illumination so that said second blade section issubstantially illuminated, and wherein said handle has an elongated rodextending from the first handle end portion.
 17. The illuminatedsurgical retractor of claim 16, wherein said handle is contoured to begripped by a hand of an operator.
 18. The illuminated surgical retractorof claim 16, wherein the handle and first blade section form an acuteangle therebetween and said acute angle is between about 30° to 65°. 19.The illuminated surgical retractor of claim 16 wherein the first bladeinner surface has a mirrored finish.
 20. An illuminated surgicalretractor for use in dissecting tissue in a subcutaneous space, saidretractor comprising: a handle having a first handle end portion and asecond handle end portion; a first blade section having a first bladeproximal end portion with a first blade distal end portion and a firstblade inner surface, extending between the first blade proximal endportion and the first blade distal end portion wherein the second handleend portion of said handle is connected to the first blade distal endportion of said first blade section such that said handle forms an acuteangle with said first blade section and wherein said first blade sectionis sized to be received in a subcutaneous space of a patient between avessel and subcutaneous tissue; a second blade section having a secondblade proximal end portion and a second blade distal end portion with asecond blade outer surface extending between the second blade proximalend portion and the second blade distal end portion, and a second bladeinner surface extending between the second blade proximal end portionand the second blade distal end portion, the second blade distal endportion of said second blade section defining an illumination input endportion; a connecting member to connect said second blade section tosaid first blade section such that said first and second blade sectionsare substantially parallel; and a connector coupled to the illuminationinput end portion, said connector is sized to optically couple theillumination input end portion to a source of illumination so that saidsecond blade section is substantially illuminated.
 21. The illuminatedsurgical retractor of claim 20, wherein said connecting member comprisesan adhesive applied to the first blade inner surface to which the secondblade outer surface is affixed whereby said second blade section andsaid first blade section are adhered together.
 22. The illuminatedsurgical retractor of claim 21, wherein the second blade outer surfaceof said second blade defines a convex curve in cross-sectioncomplementary to the first blade inner surface, and wherein the secondblade inner surface of said second blade section defines a concave curvein cross-section.
 23. The illuminated surgical retractor of claim 20,wherein said first blade section has a first blade outer surface thatdefines a convex curve in cross-section, and wherein the first bladeinner surface of said first blade section defines a concave curve incross-section.
 24. An illuminated surgical retractor for use indissecting tissue in a subcutaneous space, said retractor comprising: ahandle having a first handle end portion and a second handle endportion; a first blade section having a first blade proximal end portionand a first blade distal end portion with a first blade inner surfaceextending between the first blade proximal end portion and the firstblade distal end portion, the second handle end portion of said handleis connected to the first blade distal end portion of said first bladesection wherein the first blade inner surface has a mirrored finish andwherein said first blade section is sized to be received in asubcutaneous space of a patient between a vessel and subcutaneoustissue; a second blade section having a second blade proximal endportion and a second blade distal end portion with a second blade outersurface extending between the second blade proximal end portion and thesecond blade distal end portion, and a second blade inner surfaceextending between the second blade proximal end portion and the secondblade distal end portion, the second blade distal end portion of saidsecond blade section defining an illumination input end portion; aconnecting member to connect said second blade section to said firstblade section such that said first and second blade sections aresubstantially parallel; and a connector coupled to the illuminationinput end portion, said connector is sized to optically couple theillumination input end portion to a source of illumination so that saidsecond blade section is substantially illuminated along the lengththereof.
 25. The illuminated surgical retractor of claim 24, whereinsaid second blade section is substantially transparent.
 26. Theilluminated surgical retractor of claim 24, wherein the handle and firstblade section form an acute angle therebetween and said acute angle isbetween about 30° to 65°.